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Laparoscopic Pelvic Organ Prolapse Repair (Colposuspension) Pre- and Postoperative Instructions

Prior to Surgery

What to Expect during Your Preoperative Consultation

During your preoperative consultation, your surgeon will review your medical history and perform a physical examination. If your surgeon decides that you are a candidate for laparoscopic colposuspension, you will then meet with Ms. Chanda Nelson to schedule a date for your operation. She will review the paperwork and blood tests that you will need prior to surgery. Any scheduling changes can be made directly through her at 410-550-0412.

Note: It is the responsibility of the patient to inform Ms. Nelson of any scheduling changes/cancellations at least four weeks in advance of the surgery date out of courtesy to your surgeon, the operative staff and other patients.
All billing and insurance inquiries are handled by Ms. Laura Wheeler at 410-550-3339.

What to Expect prior to Surgery

As most insurance companies will not permit patients to be admitted to the hospital the day before surgery to have tests completed, you must make an appointment to have preoperative testing done at your primary care physician's office within one month prior to the date of surgery. Once your surgical date is secured, a letter will be faxed to your primary care physician requesting the following preoperative testing:

  • Physical exam 
  • Electrocardiogram (EKG) 
  • Complete blood count (CBC) 
  • Coagulation profile (PT/PTT) 
  • Comprehensive metabolic panel 
  • Urinalysis

These results need to be faxed by your doctor's office to the Preoperative Evaluation Center at 410-550-1391 between one and two weeks prior to your surgery date.

What to Expect prior to Surgery

Since insurance companies will not permit patients to be admitted to the hospital the day before surgery to have tests completed, you must make an appointment to have preoperative testing done at your family doctor or primary care physician's office within one month prior to the date of surgery.

These results need to be faxed by your doctor's office to the Preoperative Evaluation Center at 443-287-9358 two weeks prior to your surgery. Please call the Documentation Center at 410-955-9453 two weeks before your surgery date to confirm that this information was received.
Once your surgical date is secured, you will receive a form along with a letter of explanation to take to your primary care physician or family doctor in order to have the following preoperative testing done prior to your surgery:

  • Physical exam
  • Electrocardiogram (EKG)
  • Complete blood count (CBC)
  • Blood coagulation profile (PT/PTT)
  • Comprehensive metabolic panel (blood chemistry profile)
  • Alpha-fetoprotein (AFP) blood work
  • Human chorionic gonadotropin (HCG) blood work
  • Lactic dehydrogenase (LDH) blood work
  • Urinalysis
  • Chest X-ray 
  • Computed tomography (CT) scan of the abdomen

Preparation for Surgery

Drink only clear fluids for a 24-hour period prior to the date of your surgery.

Clear liquid diet
Remember not to eat or drink anything after midnight the evening before your surgery.
Clear liquids are liquids that you are able to see through. Please follow the diet below:

  • Water
  • Clear broths (no cream soups, meat, noodles, etc.)
    • Chicken broth 
    • Beef broth 
  • Juices (no orange juice or tomato juice)
    • Apple juice or apple cider 
    • Grape juice 
    • Cranberry juice 
    • Tang 
    • Hawaiian punch 
    • Lemonade 
    • Kool-Aid 
    • Gatorade 
  • Tea (you may add sweetener but no cream or milk)
  • Coffee (you may add sweetener but no cream or milk)
  • Clear Jell-O (without fruit)
  • Popsicles (without fruit or cream)
  • Italian ices or snowballs (not marshmallow)

Do not eat or drink anything after midnight the night before the surgery. Certain medications can be taken with a sip of water the morning of surgery.

Asprin, Motrin, ibuprofen, Advil, Alka-Seltzer, vitamin E, Vioxx, Plavix, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren and some other arthritis medications can cause bleeding and should be avoided one week prior to the date of surgery.

Bowel preparation: Drink one bottle of magnesium citrate liquid on the evening before surgery (approximately 4 p.m. to 5 p.m.) and administer a Fleets enema at home the morning of surgery to help evacuate the bowel contents. These items may be purchased over the counter at any pharmacy.


What to Expect after Surgery

Immediately after the surgery you will be taken to the recovery room, then transferred to your hospital room once you are fully awake and your vital signs are stable.

  • Postoperative pain: Pain medication can be controlled and delivered by the patient via an intravenous patient-controlled analgesia (PCA) pump or by injection (pain shot) administered by the nursing staff. You may experience minor transient shoulder pain (one to two days) related to the carbon dioxide gas used to inflate your abdomen during the laparoscopic surgery. 
  • Bladder spasms: Bladder spasms are commonly experienced as a moderate cramping sensation in the lower abdomen or bladder and are common after colposuspension. These spasms are usually transient and often decrease over time. If severe, medications can be prescribed by your doctor to decrease the episodes of these spasms. 
  • Nausea: You may experience transient nausea during the first 24 hours following surgery, which can be related to the anesthesia. Medication is available to treat persistent nausea.
  • Urinary catheter: You can expect to have a urinary catheter (Foley) draining your bladder (which is placed in the operating room under anesthesia) for approximately one to two days after the surgery. It is not uncommon to have blood-tinged urine for a few days after your surgery. 
  • Vaginal packing: A vaginal gauze packing is routinely placed at the end of the operation while the patient is under anesthesia. This packing will typically be removed the next day. 
  • Diet: You can expect to have an intravenous (IV) catheter in for one to two days. (An IV is a small tube placed into your vein so that you can receive necessary fluids and stay well hydrated; it also provides a route to receive medication.) Most patients are able to tolerate clear liquids the first day after surgery, and a regular diet the following day. Once on a regular diet, pain medication will be administered by mouth instead of by IV or shot. 
  • Fatigue: Fatigue is common and should start to subside in a few weeks.
  • Incentive spirometry: You will be expected to do some very simple breathing exercises to help prevent respiratory infections by using an incentive spirometry device (these exercises will be explained to you during your hospital stay). Coughing and deep breathing are an important part of your recuperation and help prevent pneumonia and other pulmonary complications. 
  • Ambulation: On the day after surgery it is very important to get out of bed and begin walking with the supervision of your nurse or family member to help prevent blood clots from forming in your legs. You can expect to have sequential compression devices (SCDs) along with tight white stockings on your legs to prevent blood clots from forming in your legs while you are lying in bed. 
  • Hospital stay: Length of hospital stay for most patients is one to two days.
  • Constipation: You may experience sluggish bowels for several days to a week after surgery. Suppositories and stool softeners may be given to help with this problem. Taking one teaspoon of mineral oil and milk of magnesia at home will also help to prevent constipation.

What to Expect after Discharge from the Hospital

  • Pain control: You can expect to have some incisional discomfort that may require pain medication for a few days after discharge. Afterward, Tylenol should be sufficient to control your pain.
  • Showering: You may shower at home. Your incision sites can get wet but must be padded dry after showering. Tub baths can soak your incisions and therefore are not recommended in the first two weeks after surgery. You will have adhesive strips across your incisions. They will either fall off on their own or can be removed in approximately five to seven days. Sutures underneath the skin will dissolve in four to six weeks. 
  • Physical activity: Taking daily walks is strongly advised following surgery. Prolonged sitting or lying in bed should be avoided and can increase your risk for forming blood clots in the legs as well as developing pneumonia. Climbing stairs is possible but should be limited. Driving should be avoided for at least two weeks after surgery. Absolutely no heavy lifting (greater than 20 pounds) or exercising (jogging, swimming, treadmill, biking) for six weeks or until instructed by your doctor. Most patients return to full activity an average of three weeks after surgery. 
  • Sexual activity: If a vaginal incision is required during surgery, the patient may feel pain during intercourse. Therefore, the patient should abstain from sexual activity for four to six weeks after surgery. 
  • Diet: No restrictions. Drink plenty of fluids. 
  • Medications: You can resume your usual medications after surgery with the exception of aspirin or other blood thinners, which can increase the risk of bleeding. 
  • Follow-up appointment: You will need to call soon after your discharge to schedule a follow-up visit for two weeks after your surgery with your doctor.

Our Surgeons

Photo of Dr. Mohamad Ezzeddine Allaf, M.D.

Allaf, Mohamad Ezzeddine, M.D.

Professor of Urology
Associate Professor of Biomedical Engineering
Professor of Oncology
Executive Vice Chairman, Department of Urology
Director of Adult Urology
Director, Minimally Invasive and Robotic Surgery
Expertise, Disease and Conditions: Kidney Cancer, Laparoscopic Kidney Surgery, Prostate Cancer, Robotic Prostatectomy, Urology
 
Photo of Dr. Edward James Wright, III, M.D.

Wright, Edward James, M.D. III

Associate Professor of Urology
Director, Division of Reconstructive and Neurological Urology
Chief of Urology at Johns Hopkins Bayview Medical Center
Expertise, Disease and Conditions: Incontinence, Lower Urinary Tract Reconstruction, Pelvic Floor Disorders, Pelvic Organ Prolapse, Urethral Stricture, Urinary Incontinence, Urogynecology, Urology
 

Appointments

To make an appointment for consultation, please call 410-955-6100.

In the event of an emergency and you need to contact someone in the evening hours or on the weekend, please call the paging operator at 410-955-6070 for The Johns Hopkins Hospital or 410-550-0100 for Johns Hopkins Bayview Medical Center and ask to speak to the urologist on call.

Directions to The Johns Hopkins Hospital

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